Imagine feeling a rush of warmth to your skin, accompanied by a slightly dry mouth and a heaviness in your hands and feet. But the overall sensation is coated with intense euphoria – a type of pleasure that shuts everything out and slows your heartbeat just enough to eliminate any pain or stress in your body and mind.
This is a feeling many people in the United States seek to experience everyday, a feeling with initially pleasurable effects which has led thousands of people to their deaths. This feeling is caused by drugs under the opioid class which have become so prevalent and widespread in the country and which are causing an opioid crisis.
The Centers for Disease Control and Prevention estimated that in the United States, 72,000 people died of drug overdoses in 2017, the majority of which were a result of heroin and other opioids. With such high death rates for overdoses, the issue has become less about why this issue is happening and more about how to bring the crisis to an end.
How Do Opioids Work?
Opioid drugs work by binding to the opioid receptors in the brain and other parts of the body and reducing the amount of pain messages sent to the brain. For the most part, opioids are only given to medical patients whose pain is moderate to severe. Although these drugs can be incredibly helpful to those suffering from chronic discomfort, users have the potential of developing unhealthy dependence, tolerance, and even addiction to these drugs.
The most common forms of prescription pain narcotics are oxycodone and hydrocodone, which are commonly known as OxyContin and Vicodin respectively in accordance to their brand name. A stronger medication administered in extreme cases is morphine, which is usually given to cancer patients who experience persistent severe pain. Despite the many benefits of pain narcotics, the constant use of these medications can lead to dependence and open a gateway to the recreational use of opioids with stronger effects.
Once such recreational opioid is heroin. Heroin is commonly consumed through intravenous means (injections), which increases the risk of infection otherwise not present in pills. Heroin is often cheaper and stronger than legal medications, so individuals may switch to this illicit drug if dire circumstances call for it. In addition to this, synthetic opioids such as fentanyl and carfentanil are by far the strongest and most dangerous types of opioids out there. Not only are they much cheaper and stronger than pure heroin, oftentimes heroin is laced with one of these synthetic opioids to sell less for more.
Tolerance, Dependence, and Addiction
There are many issues regarding the use and misuse of opioids, many of which stem from a general lack of understanding towards the different effects drugs have on the body. Although they may seem similar, tolerance, dependence, and addiction are vastly different things which all have different implications to the user who experiences them.
Tolerance is when the body becomes accustomed to a certain dosage of a drug, therefore requiring a higher amount to get the same effects experienced initially. It takes place when the body gets used to a substance, so eventually the user needs increasingly more of it to feel its effects.
Dependence is when the body goes through withdrawal symptoms once a certain drug is not consumed anymore. Physical symptoms of sickness are signs that an individual is dependent on a drug in order to function normally. As with tolerance, however, this does not mean the individual has addiction.
Addiction is an actual brain disorder. It’s a disease characterized by compulsive drug intake despite adverse effects. When an individual continues to do drugs even though it’s ruining their life, it means they are addicted. Someone may be dependent on drugs, or have a tolerance towards them, but it isn’t necessarily accompanied by addiction.
The Lazarus Drug
In November of 2015, the FDA approved a drug that has the potential to alleviate the opioid overdose crisis in America. Naloxone is a type of medication which works as an opioid antagonist. It suppresses the effects of opioids by binding to the opioid receptors in the brain and blocking the passage from other drugs. When an individual overdoses on opioids, their breathing slows down and eventually stops, so the administration of naloxone restores their breathing before respiratory depression can cause death.
Through this process, the medication is able to reverse the effects of an opioid overdose by essentially “jump starting” the body. It can also cause withdrawal effects which may be painful or unpleasant, such as headaches, tremors, nausea, and other non life threatening symptoms – but it can’t kill its user.
It’s been nicknamed the “Lazarus Drug” as an allusion to the story of Lazarus of Bethany, a saint who was brought back to life by Jesus after four days of dying. Although naloxone cannot resuscitate an individual after four days, it can bring them back to safety and prevent death when administered before their heart fully stops. The CDC estimated that between 1996 and 2014, more than 26,000 overdoses were reversed by ordinary people administering naloxone to individuals who had consumed excessive amounts of opioid drugs.
Unlike many other medications, one cannot misuse or overdose on naloxone – there are barely any side effects apart from mild withdrawal symptoms. In the case that naloxone is administered to someone who doesn’t have opioids in their system, nothing happens, so there’s no potential for life threatening danger or misuse of the drug.
Naloxone can come in the form of an injection, but perhaps the most common way of administration is through nasal spray under the brand name Narcan. While naloxone injections must be handled by medical professionals due to the risk of infection, Narcan can be administered by anyone at any moment without any major risks to either people’s safety. The user friendly nature of this medication makes it all the more accessible, and its potential to save lives all the more crucial.
Photo Source: HCA Today
Moral Hazard Argument
Even though Narcan seems like the miracle drug to resolve the thousands of opioid overdoses that take place in the US every year, there is an argument made against its use. Moral hazard is a term used by economists when one party involves themselves in risky activities because they know they are protected against the consequences of that risk by another party.
Within this particular context, the availability of naloxone may cause drug users to take higher doses or venture into more dangerous drugs because they know there is a chance for overdose revival. Then question then becomes: if the minimisation of the risk of an overdose can cause users to engage in more irrational and dangerous behaviours, should this safety net still be accessible?
Laws have been passed across the United States which increase access to naloxone in order to save lives, but the moral hazard argument has had pushbacks on these efforts. There is concern that if naloxone becomes more widely available, then there might be an increase in overdoses. And this isn’t an unfounded fear – there is genuine alarm that the availability of Narcan will only result in more reckless behavior by drug users.
Drug abuse, especially within the context of opioids, has become an urgent issue in the United States. In 2017, it was reported by the National Safety Council that it’s more likely that someone dies from an opioid overdose than from a car crash. While there is a 1 in 103 chance of dying from a motor vehicle crash, there is a 1 in 96 chance of dying from an opioid overdose in America.
Much of the criticism directed towards the use of naloxone comes from the fear that it might indeed make overdoses more prominent and fuel an unwanted safety net for people with addiction. But the problem then becomes less about providing a leeway for people to recklessly abuse opioids and more about how to treat the disease that is addiction.
The increased accessibility of naloxone will certainly not eradicate addiction, but it has the potential to save thousands of lives every year. Although there is fear that naloxone might fuel the consumption of opioids, this drug has a capability that will help the mortality aspect of America’s opioid crisis subside. It is therefore crucial that all people in the United States have safe access to naloxone in order to prevent further complications and deaths. It’s simply one more right step forward to making progress towards diminishing the crisis.
“How Does Naloxone Work?” Recovery First Treatment Center, www.recoveryfirst.org/how-does-naloxone-work/.
National Institute on Drug Abuse. “Prescription Opioids.” NIDA, June 2018, www.drugabuse.gov/publications/drugfacts/prescription-opioids.
National Institute on Drug Abuse. “What Are the Immediate (Short-Term) Effects of Heroin Use?” NIDA, www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use.
“Odds of Dying.” Injury Facts, National Safety Council, 2017, https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/.
Vedantam, Shankar, et al. “Life, Death And The Lazarus Drug: Confronting America’s Opioid Crisis.” NPR, NPR, 29 Oct. 2018, www.npr.org/2018/10/26/661011560/life-death-and-the-lazarus-drug-confronting-americas-opioid-crisis.